Next week is World Breastfeeding Week. Prepare yourself for an onslaught of articles, and podcasts and tweets rhapsodizing about the benefits of breastfeeding as well as an onslaught of images of breastfeeding stunts — breastfeeding in uniform, in evening gowns or naked outdoors — ironically designed to “normalize” breastfeeding. Prepare yourself for a disingenuous effort to convince you that breastfeeding is a critical issue of public health when it is nothing more than the choice between two excellent ways to nourish an infant (formula being the other).

Can lactivists promote breastfeeding by sticking to the facts?

I’d like to offer a challenge to lactivists: Can they promote breastfeeding by sticking to the facts or do they reflexively resort to grossly exaggerating the benefits?

Will they stick to the truth that the ONLY proven benefits of breastfeeding for term infants are 8% fewer colds and episodes of diarrheal illness across the entire population of infants across the first year?

Will they acknowledge that breastfeeding has no discernible impact on the vast majority of term infants?

Or will they roll out a long list of “benefits” that are based on weak or conflicting data or based on studies that were discredited long ago because they failed to take into account the impact of maternal socio-economic status on infant outcomes?

I’m going to guess that lactivists will not be able to keep themselves from exaggerating the benefits. Why not? Because it is difficult to make the case that breastfeeding is critical when you acknowledge the scientific reality that it isn’t.

One of the food/nutrition FB pages where I regularly correct nutritional misinformation has been the target of a “health spread the word about breastfeeding” post – with lots of emotive language and hashtags (the usual zealotry).

In I wade about being careful with use of language and about the benefits of BF in our society being relatively small.

Well, as expected, the backlash was unleashed. Here is just one example of the vitriol against my comments:

“Anti breastfeeding campaigners often times have a lot of personal anger or guilt over their breastfeeding journey which is totally understandable it’s an Upsetting thing for many women. Hence they feel judged by any positive breastfeeding facts and by breastfeeding promotion and by breastfeeding advocates. The irony is it’s the breastfeeding advocates who would empathise with this and know how very hard and impossible breastfeeding can be without good support. This is not about saying all women should breastfeed it’s about saying that all women who want to breastfeed are FULLY supported – which currently they aren’t. Many women are failed by the system. Many HCPs themselves aren’t supported to breastfeed in their own career and so have to give up early. No one is making these women feel guilt. It’s sad they feel guilt but they shouldn’t use that to lash out at people who are just trying to advocate and support breastfeeding. If anything the reason some breastfeeding advocates are so passionate is because they have empathy for these women that wanted to breastfeed and couldn’t and they want to help support future generations in a better way than society has thus far.”

ANother poster helpfully suggested that I must be in the pay of the formula companies.

If you’re not full of gusing enthusiam and pledging life-long commitment to the cause, you must be an embittered anti-BF formula shill. Sigh.

Okay, sorry that the picture posted directly here – I thought it would just be the link so that those who wanted to see it could click, and those who didn’t could choose not to. I can’t delete it or edit it as a guest commenter, sorry.

Sue

Huh? A Nobel Prize?

That’s like saying that, if the pancreas did not exist, someone would have to invent one…no…wait…

guest

Right? I also suspect that if breastfeeding did not exist, we’d simply not be mammals and get by like all the other animals in the world who aren’t mammals. I haven’t seen any turtles invent breastfeeding yet.

Azuran

Can you imagine what the equivalent of lactivism would be like?
Real moms regurgitate directly into their babies mouth!!!! If you use a bowl and a spoon or blended food you just don’t like your baby enough.

you know what would be way cooler? if someone could invent a way for us to be marsupials. Just think – no more childbirth complications from squeezing a big baby through a small opening. Just pop it out when it’s the size of a peanut, and tuck it in your pouch til it’s done developing. Much more sensible plan for reproducing, imo.

Azuran

Sure, but in nature, the baby has to crawl to the pouch on it’s own. Many don’t make it and die.
Some NCB crazies are already claiming that your term baby should crawl all the way to your breasts on it’s own. Imagine what they would do to those poor baby.
‘oh, it fell on the ground? Don’t worry, some babies aren’t meant to make it.’

guest

Well, we’re working on inventing the artificial womb. The baby won’t need to crawl, but could potentially be removed in a way that avoids all the common birth injuries.

Charybdis

Comment from a man, I noticed. And the VP of World Bank’s Human Development….how is he qualified to comment?

guest

They have a branch devoted to projects to improve human health, so I assume that’s what this came out of. Still completely inane.

Roadstergal

Did the inventor of formula get a dual Nobel Prize? :p

guest

Assuming there is a single inventor, he or she should have!

yentavegan

I did not choose to breastfeed because I thought breastfeeding would make my kids smarter or healthier than non-breastfed kids. I breastfed because as long as I could remember, even as a little girl I really wanted to breastfeed. I just had a very strong urge to breastfeed that defies logic.

Bonet Nuttall

I’m reading lots of posts touting all sorts of benefits for the mother- reduced risk of heart disease, breast cancer, obesity, etc.. Where can I find sources of information that give accurate statistics and studies that support or refute this?

D/

Already growling with my first ‘Happy WBW’ facebook wish of 2016. (Ironically) posted by the Human Milk Banking Association of North America, it’s an article claiming,

“It is important to distinguish the difference between choice and capacity: to be clear that, given enough up-to-date information and skilled assistance when they need it, 99.9% of new mothers will provide enough milk for their babies.”https://www.facebook.com/HMBANA/posts/10153265403182609

Roadstergal

Didn’t one of their own lactivist leaders note that almost half of primps will have delayed lactation?

You know, formula is synthetic human milk. Therefore, they’re correct in a way they didn’t intend – given up-to-date information, women will give formula and/or combo feed if breastfeeding is taking some work or just isn’t working out – and that’s ‘providing enough milk.’

D/

Yeah, it’s a fair percent of babies who will need some degree of breastmilk and/ or formula supplementation. It’s certainly more than 0.1% who will never get enough milk to grow and thrive (or even survive for that matter) if being exclusively fed their mother’s own milk. Fabricating and publicizing these miraculous numbers and using them as some sort of inspirational guarantee of adequate milk production is only increasing the recent tendency to inadequately feed breastfed babies.

How does one get a cesarean? Patient is 36 weeks with modi twins. She wants delivery by 36.6, for safety and per the literature. Doc is refusing to schedule her cesarean at 36.6, 37, or 37.1, due to weekend. Note, 36.6 is a Friday and if the patient were being induced for vaginal delivery, doc would induce Friday, but will not grant a scheduled cesarean on the same day. Don’t ask about 37.2, a Tuesday, doc is adamant 37.3, Wednesday. This is after the patient refused a 38.3 delivery, which doc originally wanted.

Patient has come a long way, is fully informed on the risks associated with greater than 36.6 week delivery of modi’s, but obviously can’t give herself the cesarean.

No health problems at this time and in the US. Switching providers seems highly unlikely.

How does one manipulate a properly timed cesarean, or demand one?

Fleur

What worries me most is the point where “breast is best” becomes “breast is perfect”, and the kind of frighteningly ill-judged decisions that some women seem to make off the back of that assumption. Vaccinate your babies? No need because breastfeeding provides perfect immunity. Vitamin K at birth? Nope, breastmilk is perfect nutrition so, if it isn’t a wonderful source of vitamin K, then obviously babies are meant to be deficient in vitamin K. Your newborn loses way over 10 per cent of her body weight when exclusively breastfed? Hey, breastmilk is the perfect food so she’s obviously just meant to be a petite baby. Want to bed-share? No need to comply with recommendations for safer bed-sharing because your superior bond with your breastfed baby means you’ll instinctively wake up just as she’s about to suffocate/ fall off the bed. (Same with baby-wearing: when did “this is a great tool if you need your hands free” turn in some circles into “babies who are worn won’t die of SIDS”?)

RMY

New parents are a nervous lot (taking care of a tiny human is a tremendous responsibility), and the woo gives more reassuring (but false) answers than conventional medicine.

Fleur

Precisely – as a new parent, I was pretty much paralysed with terror for at least the first six weeks. And the scary part is that there’s no magic bullet for keeping your child healthy (“don’t be poor” is about the best we’ve got, which isn’t exactly helpful), so the idea that there’s a secret, one-size-fits-all cure for infant mortality that “they” don’t want you to know about is incredibly seductive, even though it’s bollocks.

AnnaPDE

But there’s this thing that VERY few babies die of SIDS (or anything else really). Except it looks like your baby is going to drop dead any minute because of all these precautions that you MUST take because otherwise any number of freak accidents are certain to happen.

Meanwhile, heaps of mums are underfeeding their babies because they’re told that formula is the devil. 🙁

Fleur

God, yes. I was probably more nervous about SIDS than the average new mother because my godparents lost a baby that way in the early 80s, but I still think it’s daft that I was bombarded with information about safe sleeping during pregnancy yet nobody ever told me how to prepare a damn baby bottle safely (because there is no safe way to prepare the demon formula *scary music*).

And then there’s stillbirth, which is (I believe) much more common than SIDS but nobody ever warns women that it could happen to them. In the UK, at least, we’re ridiculously offhand about stillbirth. I remember seeing an article on the Guardian website a while back about how bad the UK’s stillbirth rates are compared to other developed countries. Most of the comments were along the lines of “well, these were obviously babies that weren’t meant to live so stop moaning”, yet the article itself specifically cited research indicating that a high proportion of stillborn babies are perfectly healthy and could be saved through better monitoring. It honestly breaks my heart how many lives we could save from being wrecked if we paid as much attention to stillbirth as we do to SIDS.

Sue

Great point.

Conventional health care providers have been encouraged to be less paternalistic and to express doubt and share decision-making. That provides lots of space for people wanting simple, directed messages to fall straight into the arms of the New Pateralists – in the form of sCAM providers and lay MWs, who will give simple, directed messages under the guise of rebellion (against The Doctor).

Tori

One of the most surprising thing about my hospital stay for the birth of my son was that I was given an option between vitamin k injected or orally. I must have looked confused (in my defence I had just given birth), because the midwife said “the paediatricians usually prefer the injected one…” Um of course, but I’m surprised we’re having this conversation.

Fleur

I actually had a bit of a meltdown at one of my third trimester appointments with my midwife because of the vitamin K issue. She’d suggested that I take a look at the template birth plan on the NHS Choices website so we could discuss it our next session. I came to our next session in floods of hormonal tears saying that I couldn’t have a baby because I was too dumb to understand the birth plan. She asked what in particular was confusing me, and I said the question about whether I was ok with my baby being given vitamin K: I’d read everything I could about it and it seemed to be a complete no-brainer, so what was I missing? She said that, in her view, I wasn’t missing anything and vitamin K is indeed a no-brainer. I said, ah cool, in that case my baby’s having it. Conversation over.

Tori

Sounds like I’m not alone then! I work in healthcare and when in training spent some time at a country hospital. I don’t recall vitamin k being discussed as a big deal, and certainly never refused.

I can’t comment about the context they are talking about, but they’re wrong that breastfeeding is “baby’s first vaccine.” First, because it’s *not* a vaccine and can only protect against a very small number of diarrheal illnesses (no protection from the other things vaccine covers: whooping cough, measles, chicken pox, polio…). But second because the *first* time a baby gets an extra immunity boost is before birth, when the mother transmits antibodies through the placenta. This is why the Tdap is recommended during pregnancy specifically. You get the vaccine while pregnant, the baby gets some protection, breastfeeding hasn’t happened yet.

So given their misrepresentation and outright lies about that aspect, I don’t trust the rest of it, either.

Tori

Oh no!! Breastfeeding causes autism! 😉

AnnaPDE

Haha, I had skin-to-skin and first time at boob while my C-section was still being sewn up, and still HepB was the kid’s first vaccine.

SporkParade

I’m always suspicious about any report that doesn’t investigate causes. Why are babies delivered by a medical professional less likely to breastfeed in the first hour than those delivered by a traditional attendant? Is it because it’s so rare to have appropriate medical care during childbirth that the woman must be in a pretty horrific state for that to happen? And, if so, isn’t this just another example of public health organizations blaming infant mortality on women who are too sick/malnourished/dead to breastfeed rather than the lack of clean water and access to formula.

Azuran

Clearly the reason all those babies are dying is because they are not breastfed fast enough. Not because of lack or proper medical care of both mother and babies, malnutrition and lack of basic life necessities like clean water.

Caylynn

In Canada, a woman in uniform would have no need to breastfeed in uniform, as she has a full year of maternity leave, and an infant should be started on solids well before then, and by one year should be relying primarily on solid foods, with breast milk offered after solids only if desired by mother and child.

Caylynn

That said, if a woman who serves in the U.S. has to be back to work before her infant is six months (which is the current recommended age for introducing solids in Canada), then she should be able to breastfeed in uniform if her baby is hungry while she is wearing her uniform.

sugarskull

Women CAN breastfeed in uniform. They CAN’T take pictures of it, and especially ones that are used in a promotional capacity. While in uniform, you are considered to be representing the service you are in, so those photos of moms in uniform breastfeeding is the equivalent of that service promoting breastfeeding. It’s against the UCMJ. ALL services have rules about breastfeeding and pumping, including giving women more time to get back to weight standards if they are doing either (which is funny, considering that breastfeeding supposedly makes you LOSE weight. More lies).

Guest

Slightly OT, but my OB was talking to me about breastfeeding yesterday, and the exchange went as follows:

“Have you noticed any changes in your breasts?” (I’m 22wk pregnant)
“Nothing new, just still sore.”
“Do you plan on breastfeeding then?”
“I hope to. If it works out, great, but if it doesn’t, formula’s fine too.”
“Oh, so you won’t stress about it?”
“Nope.”
“All right.”

It was amazing. My medical group is super lactivisty on paper, with 24 hour rooming in mandatory, and pressure to breastfeed within 1 hour of birth, with at least 6-8 good feedings in the first day (how you do that when your milk isn’t in, I don’t know), but it was SO NICE to have that interaction and know that at least a few people there aren’t all that fussed about how a baby gets fed.

Then apparently, I had a couple of pretty crappy OBs, because no one ever checked for me. It was an LC that explained to me that my breasts not changing size was probably partly why I was having so much trouble breastfeeding.

Tori

Mine didn’t ‘check’ about breast changes, although I had them anyway so IGT wouldn’t have been easily picked up antenatally anyway, unless I’d seen a LC and maybe not even then. He did warn me though that I might need to supplement due to a larger than average baby expected, and emphasised there wasn’t anything wrong with that. He also encouraged me that formula feeding was completely fine when I had issues too.

moto_librarian

My CNMs never asked either. They knew that my milk never came in the first time, but never thought to bring up the potential for IGT during my second pregnancy.

guest

Mine never checked me. The CNM at the practice said I should still try with my 2nd even with no breast changes and no milk with my first child. It was a bra fitter at the department store that clued me in that breastfeeding probably wasn’t going to happen for me.

Guest

3 babies, 4 different practices (1 left my hospital system around 25 weeks). Never asked once about potential breastfeeding problems. I only got “do you plan to breastfeed?” That’s it. I’m not saying that’s universal, of course, or that my anecdote trumps data, but….really? Where?

corblimeybot

Yeah I liked my obs a lot, but they never checked for breastfeeding issues. I had the same experience as Guest. They farmed that job out to the hospital LC – who was thankfully one of the good ones.

demodocus

OT: Some days, humanity just seems kinder than usual. Someone from church anonymously gave us 10 grand for a car. o.O Still in shock, but I’m about to sign for my first car.

Dr Kitty

Wonderful!
Enjoy it!
The kindness of strangers can be a great thing.

Charybdis

That’s amazing! And wonderful!

Congratulations!

Caylynn

That’s wonderful! Helps restore my faith in some of humanity.

Who?

How kind. And generous. So happy for you that will be an enormous help.

Sue

Wonderful – enjoy it!

OttawaAlison

I just wish Breastfeeding promotion wouldn’t include formula-shaming.

Gene

I have a “World Breastfeeding Week” t shirt in my closet that I was given during residency. On the back, in about 50pt font, it says: WIC supports breastfeeding.

I’ve always felt a bit conflicted about wearing it. On one hand, it’s fun to wear a shirt with a “dirty word”* on it. On the other, I could care less how a baby is fed as long as it IS!

*my friend once gave me a shirt with the Sistine chapel on it so I could walk around with a picture of a naked man on my chest.

OttawaAlison

My Lilith Fair tee had a naked lady on it, I couldn’t wear it the days I worked as a nanny, but on the other days I wore it all the time!

BeatriceC

My favorite t-shirt is extremely dirty if you can compute a simple integral in your head. It says “Want to”, and then the definite integral of 2x dx from x=10 to x=13, and then a question mark. If you can can compute it, it reads “want to 69?” When I was single I would wear it to bars and called it the “are you smart enough to date me t-shirt”.

corblimeybot

Should say “WIC badgers and berates you about breastfeeding, then penalizes you if you don’t or can’t breastfeed exclusively.” <–personal experience

Kelly

I still have a child who is drinking from a bottle. I think I will post a photo of us in a field while we lovingly look into each others eyes as she drinks her bottle. She will probably kick me, scratch me, and try to put her hands in my mouth as well but we can’t show the annoying side of bottle feeding, only the beautiful side.

AnnaPDE

My son drew blood when he scratched my face during breastfeeding the other day. I’m sure there’s some contrived explanation how that’s a good thing for someone’s long term health. Maybe he’s trying to get me to help with the dirt-bacteria under his fingernails?

Madtowngirl

It’s too bad I don’t really have any pictures of me bottle feeding my daughter -I would love to post that in response to every breastfeeding stunt picture I see.

Hmm, maybe I will put on one of my costumes and take my daughter outside and bottle feed her. Possibly while doing some crazy yoga pose. I’m sure I could get someone to take a picture so I can #normalizebottlefeeding

demodocus

I’m never intentionally taken any pictures of me feeding my kids milk. Other stuff, yes, because I’m impressed he managed to get peanut butter in his eyebrows and blueberry oatmeal down his back.

Erin

My husband took one of me breastfeeding. I look dead, hollow and broken. The bags under my eyes merge with the shadows under my cheekbones and the arms holding my son are marred with fresh scars.

Maybe I should post it next week.

Mrs.Katt the Cat

I have a small series of pictures I call “Bottle Benefits” – mostly pictures of other people with my baby. Her father, aunts, grandparents etc. Bottle benefits- daddy can feed baby too! Baby can eat while I eat! I don’t have to pop a boob at the butcher’s! Baby can take meds without knowing it!

Roadstergal

Next week is World Burrito Week. Yes, there are many excellent ways to feed oneself, but like most women who are really in touch with their bodies, I know that Burrito Is Best, and I will be posting continually about Normalizing Burrito.

BeatriceC

You are a woman after MrC’s heart. That man would eat burritos 7 days a week if left to his own devices.

D/

Mr D/ being left to his own mid-day devices has earned him an honorary title at his favorite lunch stop. I was recently introduced all around with a ‘Hey, come meet bean burrito man’s wife!’ And evidently there are other varieties of ‘burrito men’ among their regulars too 😉

Are you nuts

Bless your heart, you are so misguided. Clearly the fajita is the preferable tortillaed tex mex vehicle. I’m not judging, I’m just sad for you.

No, you are both wrong. Gorditas. Gorditas are the pinnacle of Mexican food.

Charybdis

Quesadillas (preferably steak)! And chimichangas.

Don’t forget the sopapillas either.

The Bofa on the Sofa

Find a place that has tortas. Authentic gorditas are definitely good, but tortas are even better.

And tex mex? Bleh!

fiftyfifty1

No. Sopes.

Nick Sanders

There was a taco stand near me that did the most wonderful sopes with some great meat choices, sadly, they’ve either closed or relocated.

There’s another place that has meats just as good, but their sopes shells aren’t even close.

Are you nuts

You’ve been brainwashed by Big Gordita!

Who?

Fajitas all the way!

KeeperOfTheBooks

See, I KNEW there was a reason I wanted Chipotle for my birthday dinner next week! Pass the steak burrito, and add a side of guac, please!

BeatriceC

Dr. Amy, you really are an optimist, aren’t you! I’d say there’s no chance in hades that the lactivists will stick with the facts, or even just minor exaggerations.

Jennifer

Is there a way to state the colds and diarrhea benefits per infant? Everyone I repeat it to hears “8% fewer colds and episodes of diarrheal illness across the entire population of infants across the first year” as meaning that their specific child has an 8% lower chance of colds and diarrhea in their first year.

Amy M

Is it the entire population of infants in the world, or 8% across any given population of infants? I guess we’d also need to know how many colds and episodes of diarrheal illness happen in an average year.

Heidi

Well, I think to even possibly prevent one cold, a formula fed baby would have 13 colds a year, and a breast fed baby would have 12. After 12 colds, is one more that big of a deal? My guess is the average baby doesn’t have 12-13 colds a year. If the average FF baby gets seven colds, then the average BF baby is going to get 6.44? Obviously, you can’t get 6.44 colds, which really means some breastfed babies are going to get the seven colds, some might luck up and only get six. (Of course, this is very simplistic.) Maybe seeing that it doesn’t promise an individual baby that much protection, they’ll get it?

The primary aim of the study was to see if a specific intervention could improve BF rates. Secondary outcomes included the incidence of various diseases.

Here is one of the results tables. It’s important to distinguish relative risk reduction from absolute risk reduction, and also to realise that only a small number of infants in bioth groups got infections.

Irène Delse

I don’t think there’s a way to go from that 8% figure across the population to the actual benefits for an individual child. This figure is an average, so different children might have a higher or a lower decrease in the number of colds, but it likely depends on their genetics, socio-economic status of the family, the climate, etc.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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